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| To go to the COVID-19 project topics list, click '''[[COVID-19 Project Topics|here]]'''. | | To go to the COVID-19 project topics list, click '''[[COVID-19 Project Topics|here]]'''. |
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| {{CMG}} {{AE}} {{S.G.}} {{NN}}<br> | | {{CMG}} {{AE}} {{S.G.}} |
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| | ==Overview== |
| | | ==Nephrologic_Disorders of COVID-19== |
| '''Complication 1: Acute Kidney Injury in COVID-19'''<br><br>
| | ==Nephrologic_Disorders risk factors of COVID-19== |
| | | ==Complications== |
| {{SK}} [[Acute Kidney Injury]], [[Acute Renal Failure]], [[AKI]], [[ARF]]
| | ===AKI=== |
| | | ====Clinical Features of AKI by SARS-CoV-2==== |
| ==[[AKI overview|Overview]]== | | ====Treatment==== |
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| *[[COVID-19]] can involve many organs leading to organ failure, one of which is kidneys that manifest with mild [[proteinuria]] to advanced [[acute kidney injury]] ([[AKI]]).<ref name="pmid32416769">{{cite journal| author=Ronco C, Reis T, Husain-Syed F| title=Management of acute kidney injury in patients with COVID-19. | journal=Lancet Respir Med | year= 2020 | volume= | issue= | pages= | pmid=32416769 | doi=10.1016/S2213-2600(20)30229-0 | pmc=7255232 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32416769 }} </ref>
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| =[[AKI pathophysiology|Pathophysiology]]=
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| *Angiotensin-converting enzyme 2 ([[ACE2]]), which is a primary receptor for [[SARS-CoV-2]] entry into cells, mostly presents in renal tubular epithelial cells as well as lungs and heart.<ref name="MalhaMueller2020">{{cite journal|last1=Malha|first1=Line|last2=Mueller|first2=Franco B.|last3=Pecker|first3=Mark S.|last4=Mann|first4=Samuel J.|last5=August|first5=Phyllis|last6=Feig|first6=Peter U.|title=COVID-19 and the Renin-Angiotensin System|journal=Kidney International Reports|volume=5|issue=5|year=2020|pages=563–565|issn=24680249|doi=10.1016/j.ekir.2020.03.024}}</ref>
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| *Despite kidney injury following [[COVID-19]] infection is less frequent than severe lung injury, [[ACE2]]: [[ACE]] ratio is higher in the kidneys compared to the respiratory system. (1:1 in the kidneys VS 1:20 in the respiratory system)<ref name="MalhaMueller2020">{{cite journal|last1=Malha|first1=Line|last2=Mueller|first2=Franco B.|last3=Pecker|first3=Mark S.|last4=Mann|first4=Samuel J.|last5=August|first5=Phyllis|last6=Feig|first6=Peter U.|title=COVID-19 and the Renin-Angiotensin System|journal=Kidney International Reports|volume=5|issue=5|year=2020|pages=563–565|issn=24680249|doi=10.1016/j.ekir.2020.03.024}}</ref>
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| * After [[SARS-CoV-2]] enters through the nasal cavity, it may travel to the kidneys and enters the bloodstream leading to severe inflammatory response activation and [[cytokine]] storm.
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| *It is thought that [[AKI]] following COVID-19 is the result of<ref name="MalhaMueller2020">{{cite journal|last1=Malha|first1=Line|last2=Mueller|first2=Franco B.|last3=Pecker|first3=Mark S.|last4=Mann|first4=Samuel J.|last5=August|first5=Phyllis|last6=Feig|first6=Peter U.|title=COVID-19 and the Renin-Angiotensin System|journal=Kidney International Reports|volume=5|issue=5|year=2020|pages=563–565|issn=24680249|doi=10.1016/j.ekir.2020.03.024}}</ref>
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| **[[Sepsis]] and [[cytokine]] storm
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| **[[Hypovolemia]] and Hypotension
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| **Hypoxemia
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| **Blood clots formation, leading to impaired blood flow in the renal arterioles.
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| *[[AKI]] is more likely to develop in the late stages of [[COVID-19]] in critically ill patients.<ref name="pmid32416769">{{cite journal| author=Ronco C, Reis T, Husain-Syed F| title=Management of acute kidney injury in patients with COVID-19. | journal=Lancet Respir Med | year= 2020 | volume= | issue= | pages= | pmid=32416769 | doi=10.1016/S2213-2600(20)30229-0 | pmc=7255232 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32416769 }} </ref>
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| [[File:AKI physiopathology COVID.PNG|600px|center]]
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| =[[AKI Natural history|Natural history]]=
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| *[[AKI]] is frequently seen among patients with [[COVID-19]] hospitalized in [[ICU]], with prevalence of 0.6-29% in China {{cite web |url=https://www.esicm.org/blog/?p=2789 |title=Acute Kidney Injury in COVID-19 Patients | COVID-19 |format= |work= |accessdate=}} and 22.2% in the USA.<ref name="pmid32320003">{{cite journal| author=Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW | display-authors=etal| title=Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. | journal=JAMA | year= 2020 | volume= | issue= | pages= | pmid=32320003 | doi=10.1001/jama.2020.6775 | pmc=7177629 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32320003 }} </ref>
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| *While, the real incidence of [[AKI]] in critcally ill patients with [[COVID-19]] is estimated between 27-85%. {{cite web |url=https://www.esicm.org/blog/?p=2789 |title=Acute Kidney Injury in COVID-19 Patients | COVID-19 |format= |work= |accessdate=}}
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| *Severe [[COVID-19]] pneumonia and [[severe acute respiratory distress syndrome]] are associated with developing [[AKI]].<ref name="PeiZhang2020">{{cite journal|last1=Pei|first1=Guangchang|last2=Zhang|first2=Zhiguo|last3=Peng|first3=Jing|last4=Liu|first4=Liu|last5=Zhang|first5=Chunxiu|last6=Yu|first6=Chong|last7=Ma|first7=Zufu|last8=Huang|first8=Yi|last9=Liu|first9=Wei|last10=Yao|first10=Ying|last11=Zeng|first11=Rui|last12=Xu|first12=Gang|title=Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia|journal=Journal of the American Society of Nephrology|volume=31|issue=6|year=2020|pages=1157–1165|issn=1046-6673|doi=10.1681/ASN.2020030276}}</ref>
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| *Approximately half of the new AKI cases following COVID-19 is mild with good short-term prognosis.
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| *If no improvement occurs during follow-up, it is contributed to higher mortality.<ref name="PeiZhang2020">{{cite journal|last1=Pei|first1=Guangchang|last2=Zhang|first2=Zhiguo|last3=Peng|first3=Jing|last4=Liu|first4=Liu|last5=Zhang|first5=Chunxiu|last6=Yu|first6=Chong|last7=Ma|first7=Zufu|last8=Huang|first8=Yi|last9=Liu|first9=Wei|last10=Yao|first10=Ying|last11=Zeng|first11=Rui|last12=Xu|first12=Gang|title=Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia|journal=Journal of the American Society of Nephrology|volume=31|issue=6|year=2020|pages=1157–1165|issn=1046-6673|doi=10.1681/ASN.2020030276}}</ref>
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| *Early diagnosis and treatment of [[AKI]] in patients with [[COVID-19]] can avoid the progression of [[AKI]] into [[ESRD]] and reduce mortality.<ref name="pmid32416769">{{cite journal| author=Ronco C, Reis T, Husain-Syed F| title=Management of acute kidney injury in patients with COVID-19. | journal=Lancet Respir Med | year= 2020 | volume= | issue= | pages= | pmid=32416769 | doi=10.1016/S2213-2600(20)30229-0 | pmc=7255232 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32416769 }} </ref>
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| =[[AKI History and Symptoms|History and Symptoms]]=
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| *Patients in the early stages of kidney failure may be asymptomatic. If left untreated, patients may progress to develop [[Azotemia]] and [[Uremia]], which occur due to the buildup of waste materials in the blood.
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| '''History and Symptoms'''
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| *Symptoms of kidney injury include<ref name=Skorecki>{{cite book |vauthors=Skorecki K, Green J, Brenner BM |veditors=Kasper DL, Braunwald E, Fauci AS |title=Harrison's Principles of Internal Medicine|url=https://archive.org/details/harrisonsprincip00kasp |url-access=limited |edition=16th |year=2005 |publisher=McGraw-Hill |location=New York, NY |isbn=978-0-07-139140-5 |pages=[https://archive.org/details/harrisonsprincip00kasp/page/n1681 1653]–63 |chapter=Chronic renal failure|display-editors=etal}}</ref>:
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| **Nausea and Vomiting
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| **Weakness
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| **Fatigue
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| **Confusion
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| **Weight loss
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| **Loss of appetite
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| ** Decrease in urine output:[[Oliguria]] or [[Anuria]]
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| **Fluid retention, leading [[edema]] and swelling of face, extremities
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| **Electrolyte imbalance; High level of [[Potassium]] which leads to [[cardiac arrhythmia]]
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| '''Physical Examination'''
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| *[[Hypotension]]
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| *Peripheral [[edema]]
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| *Rales in lungs examination
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| =[[AKI Diagnosis|Diagnosis]]= | |
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| '''Laboratory Findings'''
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| *Laboratory findings consistent with the diagnosis of [[AKI]] include:
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| **Elevated [[BUN]] level
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| ***Plasma BUN-creatinine ratio> 20 in prerenal [[AKI]]
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| ***Plasma BUN-creatinine ratio< 15 in intrinsic [[AKI]] or [[Acute Tubular Necrosis]]
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| **Based on KDIGO definition for the diagnosis of [[AKI]]<ref name="pmid22890468">{{cite journal| author=Khwaja A| title=KDIGO clinical practice guidelines for acute kidney injury. | journal=Nephron Clin Pract | year= 2012 | volume= 120 | issue= 4 | pages= c179-84 | pmid=22890468 | doi=10.1159/000339789 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22890468 }} </ref>:
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| ***Elevated serum Creatinine by ≥0.3 mg/dl (≥26.5 μmol/l) within 48 hours; or
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| ***Elevated serum Creatinine to ≥1.5 times baseline within the previous 7 days; or
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| ***Urine volume < 0.5 ml/kg/h for >6 hours
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| **Fractional excretion of sodium ([[FENa]])
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| ***([[FENa]])< 1% in prerenal [[AKI]]
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| ***([[FENa]])> 2% in intrinsic [[AKI]] or [[Acute Tubular Necrosis]]
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| **Urinary sediment
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| ***Hyaline casts in prerenal [[AKI]]
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| ***Granular or Muddy brown casts in intrinsic [[AKI]] or [[Acute Tubular Necrosis]]
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| '''Electrocardiogram'''
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| *There are no specific ECG findings associated with AKI. However, electrolyte disturbances such as hyperkalemia might lead to various ECG findings.
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| '''Ultrasound Finding'''
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| '''Other Diagnostic Studies'''
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| =Treatment= | |
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| *Management of [[AKI]] following [[COVID-19]] includes treatment of infection, identifying electrolyte disorders, and [[intravenous fluid]] administration.
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| '''AKI Medical Therapy'''
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| *Treatment of [[AKI]] following [[COVID-19]] includes<ref name="pmid32416769">{{cite journal| author=Ronco C, Reis T, Husain-Syed F| title=Management of acute kidney injury in patients with COVID-19. | journal=Lancet Respir Med | year= 2020 | volume= | issue= | pages= | pmid=32416769 | doi=10.1016/S2213-2600(20)30229-0 | pmc=7255232 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32416769 }} </ref>:
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| **Correction of hypovolemia and hypotension by the administration of adequate [[intravenous fluid]]
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| **Correction of electrolyte disturbances
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| **[[Renal Replacement Therapy]]
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| ***If AKI is unresponsive to conservative therapy
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| ***In volume overload conditions
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| ***Modality of choice in unstable hemodynamic status and [[ESRD]]
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| **Anticoagulants in hypercoagulable conditions
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| **Sequential extracorporeal therapy
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| ==References== | |
| {{Reflist|2}}
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| [[Category:Disease]]
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| [[Category:Emergency medicine]]
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| [[Category:Kidney diseases]]
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| [[Category:Nephrology]]
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